This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Monday, 17 January 2011

Hold me Back

Well at least Journalists are allowed to have their little temper tantrums. If I even look tired at the end of a 14 hour day of watching people die and about 10 relatives will go down to PALS calling me a sour faced bitch who needs smile lessons. Imagine if a Nurse or Doctor shouted "fuck it" or threw something down and shouted "fuck this I am not doing anymore"? The camera never turns off for us, the loss of temper or frustration never gets edited out and we are always seen. And compared to journalists we actually have a good reason to lose our cool.

I very nearly lost my temper with some visitors the other day. To the point that I had to lock myself in a toilet to ensure that I kept my mouth shut.

It wasn't anything more than the usual nasty ignorant crap we get from them DAY AFTER DAY AFTER DAY over an over again. But it was like the straw that broke the camel's back.

I work with a Nurse called Amanda. She works 3 shifts a week from 7AM to 9PM when she isn't doing night shifts.

Amanda is super. At the end of every shift she stays over unpaid by hours to sort things like necessary paperwork and order checks to give the next shift a helping hand. No one has asked her to do this. She does it because she cares. Can you imagine working a 14 hour day and then staying on by a couple of hours unpaid?

What she does is really helpful. When I come on duty after her I am more able to get on with direct patient care because her extra work allows me to do so. If she didn't stay over to do these things I would have to do it rather than getting straight to my patients. Then they would accuse me of neglecting them.....

Last night at 9PM Amanda handed over to me as I was taking over from her. She stayed on and did a whole bunch of stuff (answered the phone, checked orders, went downstairs to get me some blood etc etc). This allowed me to get started with the bedtime drug round and check in on my patients simulatneously. It was a big help as I also had a really unwell patient on top of all the other stuff that needs to get dealt with minutes into a new shift.

At 11PM, two hours after the end of her shift, Amanda was still at the Nurse's station. She was doing some computer work for us Night shift girls that needed to be sorted at that exact time. New patients had been admitted 10:45 PM and their details need to be entered into the computer as soon as they arrive onto the ward. Amanda kindly did this for me (I didn't ask her to) and it allowed me to continue with eyeballing all 19 of my patients, drugs for all of them, assessments for all of them, and deal with unwell patient's new orders.

Had Amanda not hung around at the end of her shift I might have been so tied up dealing with all that shit that I might have missed something with a patient that could have turned into a mega catastrophe later on. Thank you Amanda.

As Amanda was at the station at 11PM two visitors who had stayed late walked by her and spat "there is another 'angel' sat on her ass at the desk ignoring patients". Pretty harsh words coming from a couple of cunts who probably don't work at all or ONLY work 8 hour days 5 days a week.

Amanda is a saint but she is stupid too. Never make the kind of sacrifices that she is making. The public just throws it back in your face. I very nearly told those two visitors exactly what I thought of them.

I was already in a foul mood that day. Earlier in the week I had a patient go into congestive cardiac failure secondary to fluid overload. Her IV fluids had to be STOPPED. Or she would have died. We gave her some IV furosemide and she improved.

Cue the family seeing her IV fluids stopped and marching up to me. "Why are my mother's fluids not running?". I explained about the fluid over load and the CCF but I wasn't getting through. These people had already decided that I was trying to dehydrate their mother to death long before they spoke to me. So they walked away from me and went up to a cadet nurse (thinking she was a nurse) and asked her. Of course a cadet doesn't even know what CCF and fluid overload even is. Then the family marched up to the Nurse's station where a doctor (who didn't even know the patient in question) was sitting trying to review some notes on a patient that was referred to him.

"Those two Nurses (pointing at me and the cadet as if we are criminals) are trying to kill my mother by refusing to hang another bag of IV fluids".

I thought this was pretty funny considering that we need an order from a doctor to hang more IV fluids and we CANNOT just hang them because we think a patient needs them. And of course the order to stop IV fluids had come from the doctors anyway.

The doctor looked like a deer trapped in the headlights. He didn't know the patient but here he had some crazy family member who assumed that he was responsible for all patients on the ward and that he was also the "supervisor"of the Nurses. I don't think I have ever been hired, fired, or supervised by a doctor in 14 years of Nursing. This relative was looking at me real smug, as if she thought she was going to get me in big trouble with the boss. The meaner she got, the nicer I was and that really made her go mad.

I explained the patient's situation to the doctor. He told the visitor the exact same thing I did. And she was happy with his explanation.

WTF?

This has more to do with visitors having a prejudiced and 19th century view of Nurses than it had to with any concern they had for their mother.

In the old days criminals and prostitutes were pressed into Nursing when they didn't want to be there. They needed close supervision and threats to ensure that they didn't harm the patients. During the American Civil War (1861-1865) woman were considered out of place as Nurses and soldiers who misbehaved were put on "nursing duty" as a punishment. That was your Nurse workforce.

Fast forward to today. Medical care is so complicated that even the Nurses need a good education to deliver it. I had to work my butt off to get into Nursing school overseas. I had to have top grades and be in the top percentage of my class. I had to pay a lot of money out to qualify and take an expensive state board exam. I have to pay a lot of money out every year to stay qualified and continue to update my education. If I didn't do all that I couldn't be a Nurse.

I never would have made it if I didn't want to do it and take it seriously.

But members of the public still think that Nursing is a "terrible" job that losers are forced into doing. Therefore they think they have to stay on top of us. The viewpoint is also exacerbated by the fact that Registered Nurses are the lowest paid of the public sector professionals in the UK. This isn't because they actually deserve less. A hospital RN has a lot more on his shoulders than a teacher or a cop does. Nurses are undervalued in a system that is forced to make financial cuts on the frontlines of health care.

In countries like the USA a bedside direct care Registered Nurse earns far more than a police officer and a teacher. They earn more than most 3-4 year graduates upon the start of employment. I was out earning my stepsister ( who holds a master's degree in journalism from Medill) immediately upon my first job as a bedside RN in the USA. I provided direct patient care (all aspects of care from cannulation, to orders to shit cleaning) to a team of 7 patients. I think that gives people over there the idea that maybe just maybe Nurses are a bit skilled, important, and serious about their work.

These negative views held by the British public are all the more inflamed and reinforced by the terrible state our hospitals and patients are in as a result of poor RN staffing, resourcing, incompetent management etc.

I hope that this blog has helped people to see that there is more going on here than the simple "Oh the Nurses are just a bunch of pigs who don't want to be bothered" scenario.

But I don't know I don't know if it is even possible to educate people about what is going on in our hospitals. They just want someone to blame when the idea that their loved ones and themselves are not immortal. They want someone to blame when they cannot accept that sickness and old age are ugly horrible things and that medical science doesn't have all the answers.

Reminding myself of all this helped me to keep my mouth shut and not go into smackdown mode when those people insulted Amanda.

Let's watch Bill O'Reilly meltdown one more time. Isn't it just so stressful to be sat a desk reading for a teleprompter? Christ if anyone at my hospital acted like this ever we would be gone. Immediately.

Imagine this little princess having to deal with constant interruptions whilst she was trying to calculate a drip to stop someone from dying and getting blamed for their death.

Here is another one. Aren't these reporters so professional? These guys would be the first one on the story if a Nurse panicked and shouted "oh shit" when she realised that her 16 year old patient stopped breathing. I am sure that the patients and relatives would be running to PALS and the papers if they heard an explective come out of the mouth of a Nurse. Makes me laugh. He doesn't look like he is having a tough day at work to me. None of them do.

10 comments:

This post reminded me about a complaint once made about a colleague of mine. She is an angel in every sense of the word - probably the most caring nurse I know. One hectic night shift in A&E she had gone 11 hours through the night with only a slurp of cold coffee, no food, no wee, no break to take the weight off for just 5 minutes. She was seriously flagging (as ANYONE would, burning that much energy without food or drink).

Towards the end of the shift, some relative called her a moody bitch (ironically the patient was horrified)and reported her the next day for not having a smiling face, and >>> for having a few strands of hair loose out of her pony tail, hanging around her face.

"She looked messy" apparantly.

I'd like to see how tidy these people look after a few rounds of chest-compressions in a hot and sweaty resus room, hungry, dehydrated after 11 hours on their feet.

The best is when they interrupt you when you are trying to get hypostop into a nearly comatose patient to ask about "what is happening" with their loved one who only just arrived to the ward.

Then they act all paranoid and accuse you of not wanting to "share information" because you wouldn't drop what you are doing and speak to them.

What these people need is a job where they work a 14 hour day and are put in the situation where stopping to exlain to "customers" what the "plan" is gets someone else killed and themselves held responsible. I want to see if they look nice and smiley at the end of those 14 hours as well.

Until they experience that firsthand, they will continue to be pretty dumb.

And she says to me "the Nurse who looked after me for 12 hours straight was always so nice and professional. How do you people do that? If I worked for 12 hours straight all night long dealing with the same person over and over again I would punch somebody!".

I said all human beings would feel that way. Nurses are just superhuman 99% of the time. And the 1 % of the time that we lose it will end our careers in a heartbeat.

I have a little voodoo doll in my desk lolThe history of nursing in the UK is a little different due to heavy involvement by the church and other religious groups- it was often seen as a worthy profession for spinsters from wealthy backgrounds. Dear old Flo of course played her part. Biggest problem is the idea that if you pay too much then you will attract the "wrong" sort...apparently not the case with doctors. Its also female dominated, although thats not the case in all countries.What we need is a proper fly on the wall style documentary set in ED and AAU- much like the recent channel 4 series about the cost of drinking etc in the young or that other one Coppers (so plod thinks that the great unwashed are a pain in the arse...who would have guessed!). What we get are soaps like Greys Anatomy and Holby City and this is what the ignorant believe.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.